After years of advocacy by AAPM&R and its physician volunteers, the Medicare Payment Advisory Commission (MedPAC) announced in its June 2024 report to Congress that it is halting its work on developing a recommendation for site-neutral payment policies for care provided in the Inpatient Rehabilitation Facility (IRF) setting. This represents a major victory for both providers and patients in the IRF setting and comes after intense, sustained advocacy from AAPM&R and other stakeholders.
In its report to Congress, MedPAC acknowledges that comparing patients treated in IRFs and SNFs and their outcomes was significantly more challenging than expected. For background, MedPAC is an independent legislative branch agency established by Congress in 1997 to advise on issues affecting the Medicare program, including payment systems.
Over the years, the Academy worked to ensure that physiatry’s voice was taken into account during MedPAC’s ongoing deliberations on this issue and collaborated with other stakeholder organizations to advocate against site-neutral payment proposals and the development of a Unified Post Acute Care Prospective Payment System. These efforts included submitting and co-signing numerous comment letters, participating in multiple Technical Expert Panels (TEPs), meeting with Congressional offices and MedPAC staff, testifying before the U.S. Congress, and creating Principles for a Medicare Unified Post-Acute Care Payment System to advocate for prioritizing patient needs.
While MedPAC’s decision to halt efforts to develop a recommendation for site-neutral payment policies in the IRF setting is positive news for physiatrists and the patients who rely on PM&R for their healthcare, the report included a recommendation to lower IRF payments by 5% for FY2025. The Academy does not support this recommendation, and it would require a Congressional mandate.
The report also addresses other steps the Centers for Medicare and Medicaid Services (CMS) could consider taking, including improving the definition and identification of patients that do or do not require IRF care, gaining information from the ongoing IRF Review Choice Demonstration (RCD) project, and exploring other approaches to increase auditing of IRF admissions. Furthermore, the full report includes other important recommendations related to updating physician payment rates, boosting participation in alternative payments models, and prior authorization reform in the Medicare Advantage program. The Academy continues to actively engage with MedPAC, Congress, and CMS on payment and coverage issues and will monitor and respond to any further related developments.
Overall, the MedPAC decision marks a huge and long-fought victory for AAPM&R, and we are thrilled with this positive development! If you have any questions or comments on MedPAC’s June report to Congress, please contact the AAPM&R Health Policy team at healthpolicy@aapmr.org.
On September 7, 2016, former AAPM&R President, Greg Worsowicz, MD testified at the U.S. House of Representatives Ways and Means Committee's Health Subcommittee hearing on Incentivizing Quality Outcomes in Medicare Part A. His testimony placed an emphasis on improving the quality and efficiency of patient care through payment reform measures and value-based purchasing in the post-acute care (PAC) sector.